Abstract

Introduction

The number of total hip replacements taking place across the UK continues to grow. In an ageing population, with people living longer and placing greater strain on their prostheses, the number of peri-prosthetic femoral fractures is increasing. We studied the economic impact this has on a large university teaching hospital.

Current perception is that standard Cefuroxime only [C4] based prophylaxis regimen demonstrated higher association with C Difficile (C. Diff) diarrhoea. This has prompted change in antibiotics prophylaxis combination regimens like Flucloxacillin-Gentamycin (F-G], Teicoplanin- Gentamycin [T-G] and single dose Cefuroxime-Gentamycin [C-G]. The current study was done to investigate the association of C. Diff diarrhoea and surgical site infection (SSI) rate with Cefuroxime only regimen prophylaxis in fracture neck of femur surgery. A retrospective analysis for 2009–2012 was performed for 1502 neck of femur fracture patients undergoing surgery. The factors studied were ASA grade, SSI, C. Diff diarrhoea rates in patients with Cefuroxime (induction plus two doses) based prophylactic regimen. The data was obtained from coding department and further streamlined based on microbiology. 1242 patients were included in the study who received Cefuroxime only regimen. The Male : Female distribution was 353 : 889. The average ASA grade was 3. The analysis demonstrated that C. Diff diarrhoea rate in the study population was 1.29%. The SSI rate stood at 3.06% with superficial infection at 2.5 % and deep at 0.56 %. Our single centre based study demonstrated low C. Difficile related diarrhoea rates with Cefuroxime only regimen. The SSI rates were also low as compared to the current literature thus concluding that Cefuroxime only antibiotic regimen can safely be administered in neck of femur surgery.

Introduction

As modern day lifestyle is becoming more active so is the incidence of meniscal injuries on rise. An injury to the meniscus is a common orthopedic problem with the incidence of meniscal injury resulting in meniscectomy of 61 per 100,000 populations per year. The common practice in diagnosis of the meniscal injury involves clinical examination followed by radiological or arthroscopic confirmation. The clinical tests commonly performed are joint line tenderness (JLT), McMurray's Test (Non-weight bearing test) and Childress Test (Weight Bearing Test).

Introduction

The assessment of the accuracy of reduction of the ankle syndesmosis has traditionally been made using plain radiographic measurements. Recent studies have shown that computerized tomography (CT) scan is more sensitive than radiographs in detecting diastasis. The ethos has now therefore shifted towards CT scan assessment of the syndesmosis. There is however no validated method to scan the syndesmosis and measure it on the CT scans. This exposes the patient to significant radiation risk and also to anxiety from inappropriate interpretation from these scans.

The objectives of this research project are to investigate the current practice of CT scanning the syndesmosis at a University Hospital and to devise a new CT protocol to reduce radiation exposure to patients and to assist surgeons in interpreting the observations.

Introduction

Meniscal injuries are very common cause of knee pain and resultant attendance to the orthopaedics or sports medicine clinics. The current protocol stands at clinical examination at first contact and establishing a diagnosis with clinical indicators like joint line tenderness, McMurray's, Apley's and weight-bearing test for meniscal pathology followed by MRI scan to confirm the diagnosis. Either surgical or conservative management follows this. We aim to assess clinical examination alone provide sufficient evidence for further management of meniscal injury and does a role of MRI scan exist to corroborate the findings.

Aim

To determine the effect of the use of radial extracorporeal shockwave therapy (rESWT) in the treatment of patellar tendinopathy.

Injury to the syndesmosis occurs in approximately 10% of all patients with ankle fractures. Anatomic restoration of the syndesmosis is the only significant predictor of functional outcome. Several techniques of syndesmosis fixation are currently used such as cortical screws, bioabsorbable screws and more recently introduced suture-button fixation. No single technique has been shown to be superior to the others.

The objective of this research project is to investigate whether treatment with a tightrope (suture-button fixation) gives superior results than the use of a cortical screw in the treatment of acute syndesmotic ankle injuries with regards to function, pain, satisfaction and return to normal activities.

Research Ethics Committee approval was obtained. 40 patients with syndesmotic ankle injuries associated with diastasis were prospectively recruited, 20 in each group. Patients were randomized to one of the 2 groups. At 12 weeks, American Orthopaedic Foot and Ankle Society (AOFAS) scores and a computerized tomography (CT) scan of both the ankles was obtained. At 1 year, AOFAS scores and satisfaction was assessed.

32 patients have been recruited so far, 20 in the tightrope group and 12 in the cortical screw group. Mean AOFAS scores at 3 months post-op were 90.67 in the Tightrope group and 84 in the screw group. The difference was not significant (p= 0.096). CT scans revealed that the quality of syndesmosis reduction was equally good with both the techniques. Metalwork prominence was common with both the devices.

ECSWT has been on the medical horizon for last 30 years mainly in urology for urolithiasis and has found a parallel use in orthopaedics for various chronic soft tissue conditions like Tendoachilles tendinoses and plantar fasciitis etc. ECSWT acts a piezoelectric device releasing acoustic energy and causing micro-trauma activating cytokine mediated response stimulating local angiogenesis and tissue repair.

Introduction: Ankle fractures are the most common fracture presenting to any trauma unit in the country with an incidence of 100 per 100,000 in a population. The management and the outcome will very well depend on the mechanism of the injury but there is a window of opportunity of atleast 24hr before the swelling sets in making it technically difficult to operate and hence lengthening the hospital stay with a substantial financial cost. In times where the public health fundings are set to be rolled back and Department of Health been asked to contribute £2.3bn to the Treasury’s £5bn of public spending cuts in2010/1, health economics becomes a vital thread in consideration of treatment planning.

Aim: The study was aimed at determining the delay in definitive fixation of the ankle fractures from the time of presentation to the hospital and the reasons entailing the delay with a resultant economic negative resonance of it on the hospital budget spreadsheets and for the patient.

Method: A retrospective review of all ankle fracture patients operated during Sept 07 to Aug 08 in this hospital was performed. Electronic records were evaluated to identify the waiting times for the surgery and the reasons thereof. Calculations were performed based upon the days lost and calculated against the national minimum wage of £5.73 an hour for adults (workers aged 22 and over) and £4.77 an hour for workers aged 18 to 21 inclusive (often known as the developmental rate). Cost to the trust because of the extra stay was calculated as well.

Results: Total number of patients operated for ankle fracture during the study period was 159. The mean waiting time for surgery was 4.9 days (range 1 to 7.8 days). The mean duration of in-hospital stay for the procedure was 12 days. The commonest cause for the delay of surgery was soft tissue swelling (50%). The total number of patient days lost while waiting for selling to recede was 779.1. Based on the minimum wages considering 8 hours of a working day, the total economic loss to the GDP was approximately £35713.9. With the average cost of hospital stay per day being £ 365 patient the total expenditure to the trust for waiting for the ankle selling to recede was 1788 per patient.

Conclusion: Considering the current economic climate, which is set to affect the spending on the health care, its over time that economic consideration is given while considering the promptness of the action with NCEPOD also suggesting that operatic can be done at night if resources available. With European working time directive in play from august 2009 and open reduction and internal fixation considered a index operation it is possible to operate timely by a fresh surgical team.